What pregnant women should know about the coronavirus

Pregnant women don't seem especially vulnerable to COVID-19, but may be more at risk for serious illness if they do acquire it.

• Pregnant women are concerned and confused about what the novel coronavirus might mean for them, their births, and their future children, as evidence and advice keeps changing. 
• Pregnant women don't seem to be especially susceptible to the illness, but they may be at risk for more severe cases if they do acquire it.
• It appears unlikely that the virus can transmit in utero, and unlikely but not impossible for it to be passed on in breastmilk. 
• But it is possible for infants to get COVID-19; most cases are mild or asymptomatic, but rarely, it can be serious.
• Pregnant women should continue their prenatal appointments, take serious precautions to prevent contracting the virus, and seek mental-health support. 
• Visit Business Insider's homepage for more stories.

When Jen Judson announced her second pregnancy in October 2019, she never imagined her mom wouldn't be there for the birth, her husband wouldn't be able to stay in the hospital room with her post-delivery, and that the months leading up to the late April birth would be riveted by anxieties related to a virus no one had heard of. 

She worried about contracting the virus, being separated from her baby after the birth, running out of diapers, and following medical advice that could later be overturned.  

"I'm feeling less in control, more worried, as new data comes in about infected infants and pregnant women, and more worried about the state of our world and country when the baby is born," Judson told Business Insider in March. 

Lauren McCauley, who's due in early fall, shared similar anxieties. "I feel like we don't know enough about this virus; however, what we do know seems to worsen daily," she told Business Insider. "One moment they are saying pregnant women should be OK, then a week later, the UK is recommending pregnant women stay home for three months." 

Researchers are doctors are still learning exactly how COVID-19, the disease the coronavirus causes, affects pregnant women and their future babies. Pregnant women should continue their prenatal appointments, take precautions to protect themselves, and seek support. Here's what else research and experts suggest as of mid-September. 

Pregnant women are an at-risk population for COVID-19 

Pregnant women are at greater risk of severe morbidity and mortality from other respiratory infections like the flu, so they "should be considered an at-risk population for COVID-19," according to the American College of Obstetricians and Gynecologists.

Still, they don't seem be especially susceptible to COVID-19 the way age or conditions like lung or heart disease does, Dr. Jane van Dis, an OB-GYN who serves as medical director at the telemedicine network Maven, told Business Insider. 

"While I think pregnant women should practice every degree of social distancing that they can because that is just smart, I don't think pregnant women should feel a sense of panic," she said. "We're just not seeing the data to show that the virus is attacking their immune system in the same way as someone, say, over the age of 70."

There is a racial disparity, however, with an analysis out of the CDC finding that Black and Hispanic pregnant women seem to be disproportionately affected by COVID-19.  

All women and their families should do what they can to protect themselves from the illness. 

That means taking social distancing seriously (van Dis recommends pregnant women have someone else get their groceries, for instance), practicing excellent hygiene, and avoiding anyone who seems sick.

Women should continue their prenatal visits but may consider making some virtual, said van Dis, whose platform digitally connects women to providers including maternal-fetal medicine specialists, midwives, doulas, mental-health providers, lactation consultants and more. 

If pregnant women do get COVID-19, they may be more likely to be hospitalized and can have severe illness 

If pregnant women do get the virus, they may be at increased risk for hospitalization, ICU admission, and mechanical ventilation, according to the largest report of its type, the same one out of the CDC June 25.

It was unclear, however, if these hospitalizations were related to COVID-19 or pregnancy, labor, and delivery, so the findings should be interpreted cautiously. And, it was still rare for pregnant women to need serious care, with 1.5% admitted to the ICU and 0.5% put on ventilators. 

A September 16 report out of the CDC of about 600 hospitalized pregnant women with COVID-19 found higher rates of ICU care and ventilation among the 272 with symptoms. 

About 16% of those with symptoms were admitted to an ICU, 8.5% required invasive mechanical ventilation, and two died. 2.2% of all the women experienced pregnancy loss. 

An earlier investigation of 147 pregnant women in China who either had or were suspected to have COVID-19 found that only 8% had severe cases and 1% had critical cases. 

Women who have obesity and women of color seem to be more susceptible to severe illness, with another September 16 CDC report finding that 44% of pregnant hospitalized for COVID-19 were obese. 

A study out of the UK found that more than half of pregnant women who were admitted to the hospital with COVID-19 were Black or from other minority ethnic groups.

Marian Knight, the study's lead, previously told Insider more qualitative research involving talking to women about their experiences is "urgently needed" to help understand what puts pregnant women of color at such risk for COVID-19. 

There is some evidence that pregnant women with COVID-19 could pass it to their babies in utero 

Prior to March 26, research suggested pregnant women with COVID-19 could not pass on the disease in utero. 

A Lancet study of nine pregnant women in Wuhan who had COVID-19, for one, found their babies tested negative. There was no evidence of the virus in breast milk, amniotic fluid, or cord blood, either. 

And, of the 34 cases of babies born to women with COVID-19 that were discussed in a March 12 CDC seminar for medical professionals, none tested positive for the illness. 

But a trio of studies out March 26 brought those conclusions into question, in part by showing how some babies still tested positive for COVID-19 when strict prevention measures were taken after birth.

In two of the studies, researchers found evidence of a certain antibody in some of the babies' blood with only one likely explanation: The coronavirus crossed through the placenta and prompted them to appear.

"These two papers give evidence that COVID-19 can likely be vertically transmitted from a mother to her fetus," Dr. Jessica Madden, a pediatrician and neonatologist who serves as medical director of Aeroflow Breastpumps, told Business Insider. 

One case report out July 7 also described a pre-term infant who tested positive for the virus when they were two days old. 

Still, it seems most babies born to COVID-positive mothers don't get infected, thanks to strict hospital protocols. Of the 24 babies born to COVID-positive moms in Los Angeles County, for instance, none tested positive for the virus. 

Even a small study finding placental damage, presumably due to the virus, in pregnant women, none of their babies acquired the illness. 

Babies and infants can be infected, 90% of the time they're asymptomatic or have mild symptoms 

While babies and children seem to be less vulnerable to the virus than adults, they can acquire the infection, and in some cases, it can be serious. 

In a study out March 17 of 2,000 kids in China who were diagnosed with COVID-19, researchers found that infants have the highest risk of developing severe or critical infections. Just over 10% of all infants in the study ended up in a severe condition, compared to 7% of kids aged one to five years old, 4% of six- to 10-year-olds, 4% of 11- to 15-year-olds, and 3% of older teenagers.

However, 90% of the children were either asymptomatic or had mild or moderate COVID-19 symptoms, like fever, fatigue, sore throat, cough, or shortness of breath. 

Delivering with COVID-19 can make other complications more likely, but babies can still be breastfed 

Like any respiratory illness, COVID-19 can make it more likely for pregnant women to have complications, namely preterm birth, according to the CDC.

Another study in the journal Translational Pediatrics of 10 Chinese newborns whose moms have COVID-19 found six developed shortness of breath, two had fever, two had abnormal platelets and liver function tests, and one experienced vomiting. One went into septic shock and died, Madden summarizes on her blog. 

But, like much of the research on the topic, the sample size was small and there's no way to know if those complications were caused by COVID-19 or other factors, or some combination. 

Still, Madden wrote, pregnant women with COVID-19 should plan to give birth in a hospital, where they must follow CDC recommendations for managing them and their newborns to reduce the risk of transmission after birth. That may mean putting moms and their babies in separate isolation rooms, or keeping mom and newborn six feet apart, Madden said. 

"Each hospital is following the CDC's guidelines based on their own local resources and hospital censuses," she said. 

After delivery, as of June 25 the CDC still recommended pregnant women with COVID-19 breastfeed because there's no proof that the virus can pass through breastmilk, though there is some evidence that the substance can carry the virus's RNA. 

New moms with the virus should wear a mask, though, and naturally, wash their hands thoroughly beforehand. 

"If a woman wants to take extra precaution, think about pumping milk and then having someone else feed the baby," van Dis said. 

Seek help and support

It's true that there's a lot experts don't know about how the novel coronavirus affects pregnant women and their babies, and it's natural to feel anxious about the unknown.

Pregnant women and new moms, who are already vulnerable to depression and anxiety, are experiencing remarkably high rates — 41% and 72% respectively — of those symptoms now, one report showed. 

Manage the anxiety but set parameters around how much you read about or watch news about the issue, Julie Pike, a clinical psychologist in Chapel Hill, North Carolina, who specializes in anxiety disorders, previously told Insider. 

Too much exposure, especially from sketchy sources, can make consumers overestimate threat and underestimate their coping abilities, which is a recipe for anxiety. 

It's also important to reach out to others — mental health professionals, friends, support groups, or all of the above — for social support during such an isolating time, with many different resources available for virtual mental-health help. 

"There are going to be a lot of emotions, some of which are sadness, grief and the unknown," van Dis said. "Just know that connecting with people who are there to support women is essential for mental health."